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This guest post is from Dr. Aleksandra Popadich. Dr. Popadich came all the way to Las Vegas from New Zealand because she watched Dr. Attai’s tweets from the 2016 conference!

Oncoplastic surgery is going to become a part of breast surgeon’s repertoire.

The development of these skills will enable us to achieve good local control and better cosmetic results which will improve the quality of life and survivorship of our patients.

Our ability to perform oncoplastic surgery will never diminish the need for plastic surgeons in the management of breast cancer, in contrary, I believe that our relationship with plastic surgeons has potential to improve as it will encourage communication and collaboration.

What are adequate margins for ductal carcinoma in situ?

Dr Morrow’s presentation on margin’s in DCIS was excellent. A negative margin in DCIS does not guarantee the absence of residual disease within the breast.

The margin of at least 2mm is associated with reduced risk of ipsilateral breast recurrence relative to the narrower margin in patients receiving whole breast radiotherapy. Margin wider than 2mm is not associated with the reduction in the incidence of ipsilateral breast recurrence. Also, the margin of less than 2mm alone is not an indication for mastectomy.

If there is a presence of invasive carcinoma in the resection, then the invasive carcinoma guideline of no ink on tumour should be used. If only microinvasion is present, then the DCIS guideline of 2 mm should be utilised.

Comments

Sangeetha Kolluri

Date: 8 May, 2017

So, i actually disagree with this assessment of Dr. Morrow’s data. The strength of the study was moderate at best, and it assumed that only 1/5 patients were compliant with endocrine therapy. In my multi-specialty oncology practice, we have a much higher rate of compliance. Many surgeons question the wisdom of a wider margin necessary for DCIS (a non-invasive breast cancer with a 100% survival rate) compared with invasive breast cancer (with a variably lower survival rate).

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